Active NPI
Bergen Surgical Specialists, PA
- Specialist
- Hackensack, NJ
National Provider Identifier
1003963158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA59895
- Legal business name
- BERGEN SURGICAL SPECIALISTS, PA
- Practice address
- 211 Essex St
Suite 102
Hackensack, NJ 07601-3231 - Phone
- (201) 487-8882
- Fax
- (201) 487-0943
- NPI assigned
- Jan 4, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gregory T. Simonian, MD
- Title
- President
- Phone
- (201) 446-8202
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA59895 | NJ | Primary |
Addresses
Primary practice location
211 Essex St
Suite 102
Hackensack, NJ 07601-3231
Mailing address
211 Essex Street
Suite 102
Hackensack, NJ 07601
Phone (201) 487-8882
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6209009 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070118000485 | NJ | Part B Supplier - Clinic/Group Practice | 0244231215 |
Receives reassigned benefits from 8 practitioners Practice locations: Oakland, NJ; Hackensack, NJ |
National Provider Directory
National Provider DirectoryLocations
211 Essex St
Ste 102
Hackensack, NJ 07601
Phone (201) 487-8882
20 Prospect Ave
Ste 516
Hackensack, NJ 07601
Phone (201) 488-8989
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1713225600000",
"number": "1003963158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 ESSEX STREET",
"address_2": "SUITE 102",
"city": "HACKENSACK",
"state": "NJ",
"postal_code": "07601",
"telephone_number": "201-487-8882",
"fax_number": "201-487-0943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 ESSEX ST",
"address_2": "SUITE 102",
"city": "HACKENSACK",
"state": "NJ",
"postal_code": "076013231",
"telephone_number": "201-487-8882",
"fax_number": "201-487-0943"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BERGEN SURGICAL SPECIALISTS, PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-04",
"last_updated": "2024-04-16",
"status": "A",
"authorized_official_last_name": "SIMONIAN",
"authorized_official_first_name": "GREGORY",
"authorized_official_middle_name": "T.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "201-446-8202",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "NJ",
"license": "MA59895",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6209009",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hackensack, NJ
- Bergen Psychiatric Associates
- Bergen Psychiatric Associates
- Bergen Psychiatric Associates
- Bergen Psychiatric Associates
- Bergen Spine Associates
- Bergen Urological Associates,PA
- Bergen Volunteer Medical Initiative
- Bergen Women'S and Adolescent Care, LLC
- Bergen'S Promise, Inc.
- Berger Learning Group, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.